Arthroscopy: The Journal of Arthroscopic & Related Surgery
Current conceptsDiagnosis and treatment of chronic painful shoulder: Review of nonsurgical interventions
Section snippets
Etiology of shoulder pain
The anatomy of the shoulder is complex and is composed of bone, muscles, tendons, and ligaments. The shoulder joint itself is made up of 4 articulations: the glenohumeral joint, sternoclavicular joint, acro-mioclavicular joint, and scapulothoracic articulation.6 Chronic dysfunction of any one component can result in failure of other components and potentially irreversible structural damage. The precise cause(s) of shoulder pain within the joint structure is unknown. However, it is presumed to
Acute versus chronic pain
Acute pain is defined as pain associated with actual or potential tissue damage, which is of recent onset and probably limited duration.16 Acute pain usually has an identifiable relationship to injury or disease, whereas chronic pain commonly persists beyond the time of healing and often has no identifiable cause.16 Importantly, there is no absolute distinction between acute and chronic pain, but the temporal transition is most often reflected in the ineffectiveness of the initial intervention.
Diagnosis of shoulder pain
The differential diagnosis of shoulder pain remains a challenge for physicians and there is much discrepancy in the literature regarding diagnostic criteria. Indeed, in a study in which 3 consultants separately examined the same 26 patients with shoulder pain, complete diagnostic agreement was reached in only 46% of cases.24 In another study of 201 patients with shoulder pain who were independently examined by 2 physiotherapists, the percentage of diagnostic agreement was 60%.25 Similar studies
Differential diagnosis of chronic regional pain syndrome
Although not the prime focus of this review, which covers chronic shoulder pain of musculoskeletal origin, there are aspects of chronic shoulder pain that do not have a musculoskeletal etiology but are neurologic-based disorders, such as chronic regional pain syndrome or reflex sympathetic dystrophy (RSD). Differentiating these patients from those with pain disorders with a musculoskeletal pathophysiology is important, particularly in those with severe or burning pain. These patients may have
Osteoarthritis
Early symptoms of OA are characterized by pain with use.32 However, as the disease advances, there may be pain at rest and limitation of joint function. Moderate pain on shoulder movement with crepitation and functional limitation may be seen on physical examination and direct palpation over the joint may elicit pain and tenderness. Abduction against a fixed scapula isolates the movement of the glenohumeral joint and aids diagnosis.
Rotator cuff tear
Rotator cuff tears are characterized by pain at the lateral,
Radiograms and arthrograms
Plain radiography is the first step in diagnostic imaging, and may be used to diagnose OA, tendinitis or bursitis (Table 2).11 Arthrography was the diagnostic test of choice before MRI.11 While arthrography is able to identify complete rotator cuff tears, bursitis, or adhesive capsulitis, it is invasive and relatively poor at diagnosing a partial rotator cuff tear.11, 17
Computed tomography, MRI, and ultrasound
Computed tomography (CT) scanning may be useful in diagnosing bony lesions, subtle dislocation, labral tears, and full rotator
Acute painful shoulder
Current therapy for acute painful shoulder includes rest and physical therapy,3, 40 oral nonsteroidal anti-inflammatory drugs (NSAIDs),3, 40, 41, 42 intra-articular corticosteroids,3, 40, 42 or intra-articular sodium hyal-uronates.43, 44 Of note, a 2002 Cochrane report concludes that there is insufficient evidence to support or refute the benefit of corticosteroids in treating shoulder pain.45
Chronic painful shoulder
Current nonoperative treatment for chronic shoulder pain is initially conservative, using rest, ice,
Conclusions
Conditions of the shoulder are a common cause of chronic musculoskeletal pain and contribute to the considerable lost productivity and high cost associated with this form of chronic pain. Currently, a paucity of information exists regarding the relative significance of individual underlying pathologies, or of the interrelation between them in eliciting the final clinical symptoms. It appears that the various symptoms associated with chronic shoulder pain are not exclusive and may represent a
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Relationship between pain and range of motion in frozen shoulder
2023, JSES InternationalShoulder structure and function: The impact of osteoarthritis and rehabilitation strategies
2022, Journal of Hand TherapyCitation Excerpt :Activity level and pain also contribute to the shoulder ROM deficits in the aging population.29 Shoulder pain affects between 20% and 50% of adults.65 Common shoulder conditions (eg, rotator cuff tears, tendonitis, adhesive capsulitis, and osteoarthritis) present with inflammation, stiffness, and pain which can directly limit ROM by 10%-50%.23,66,67
Current concepts on management of cuff tear
2022, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :While adopting for surgical intervention, all sources of pain should be considered. The sources of pain are cuff tear, subacromial bursa, biceps tendon attachment, a tight capsule, degenerative symptomatic acromioclavicular joint and a tight subacromial space with hooked acromion.16 So the surgery should address all these potential pain generating pathologies.
Capsular Injury and Inflammation
2020, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Adhesive capsulitis is a condition characterized by inflammation of the glenohumeral joint capsule and synovium. Typical clinical features are progressive onset of pain and decreased range of motion with active and passive movement of the shoulder.58 These inflammatory changes may be primary, occurring in the absence of preceding trauma or other insult, or secondary, occurring as a result of prior injury, surgery, or repetitive trauma.59
Supported by Sanofi-Synthelabo, Inc., New York, New York.